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SNORKELLING CHARTER FORM, Jetty Dive Centre – Coffs Harbour, NSW
2023 - SNORKELLING CHARTER FORM, Jetty Dive Centre – Coffs Harbour, NSW
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Full Name
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Street Address
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City/Suburb
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State/Territory
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New South Wales
Queensland
Australian Capital Territory
Victoria
South Australia
Western Australia
Northern Territory
Tasmania
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Postcode
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Mobile Number
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Email Address
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Birthday
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Please note your full birthday. If you are under the age of 18 years old, signed consent of a parent is required (See below)
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YYYY
Date of Snorkelling Trip
*
If you are snorkelling with us for more than one day, pick the first day.
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DD
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YYYY
Parent/Guardian Consent
As a Parent or Guardian for the person as listed at the top of this form, note your Full Name as a confirmation for consent of participation in this activity and agreement to LIABILITY RELEASE, WAIVER AND ASSUMPTION OF RISK AGREEMENT
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